#WeNurses - Thursday 30th January 2020 8pm (GMT Standard Time) Learning from Deaths

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This chat is guest hosted by @smillichope @HeatherStacey7

Gosport / Education aspects

Learning from Deaths

   

Stephanie Millichope "I am a specialist community public health nurse and have been in nursing for 22 years.  My career is focused on patient safety, experience and quality of care having worked in acute and community provider settings, CCGs and NHS England.  I am currently a patient safety fellow funded by Health Education England and hosted by the Kent Academic Health Science Network. A colleague and I based in Dorset have been asked to look at the educational aspects of the Gosport Independent Inquiry published in 2018 and complete a year-long project in relation to learning from deaths."

Heather Stacey  " I trained as an Occupational Therapist in London over 25 years ago and since then have worked in Oxford, Edinburgh andDorset in a variety of clinical settings within the NHS. I specialised in mental health and completed my Masters in Advanced Mental Health. Since April 2019, I have been in the role of Patient Safety Fellow. This post is funded by Health Education England and is a national role to look at the Learning from Deaths post the Gosport Independent Inquiry."

The Gosport Review was published following an investigation into the use of diamorphine and syringe drivers at the Gosport War Memorial Hospital.  Concerns were raised as early as 1991 by nursing staff stating consideration was not being given for the use of milder sedatives. The report concluded that as many as 650 people had their lives shortened while in hospital. 

   

Themes from Gosport included

o  Lack of robust prescribing guidelines with patterns of anticipatory prescribing that became the norm at the hospital

o  Judgements/decisions were often not justified clinically and did not consider patients’ or families’ views

o  Family voice not heard – seen as “trouble-makers”

o  Cross system working a challenge - disparate organisations involved and not communicating

o  Staff training/supervision not in place

o  Culture of blame/defensiveness/denial

o  Frontline staff not listened to

o  Systemic problems not recognised.

   

In relation to the above themes and as part of our learning from deaths project, we have had over 70 conversations with staff of different grades, backgrounds and professions.  Our focus is on what helps staff communicate with patients and relatives as well as other clinicians, both internally and externally around the time of death.  We have also asked about what enables staff to learn and what are the potential barriers. 

We would like our Twitter chat to focus 2 key themes from the project which are communication and staff well-being and resilience.

  1. What do you think helps staff talk about death and dying with patients?
  2. What do you think helps staff communicate with bereaved families/carers/friends?
  3. Tell us about what helped you develop or learn skills to talk about death and dying with patients and their families/carers.
  4. What support do you receive at work when there is a death?
  5. How does resilience relate to your ability to care for patients/families and carers around the time of death?

    

Useful links

The Gosport Independent Panel 2018

https://www.gosportpanel.independent.gov.uk/

National Quality Board Guidance - Learning from deaths: Guidance for NHS trusts on working withbereaved families and carers 2018

https://www.england.nhs.uk/wp-content/uploads/2018/08/learning-from-deaths-working-with-families-v2.pdf

Health Education England – Learning from Deaths E Learning

https://www.e-lfh.org.uk/programmes/learning-from-deaths/





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 Chat Summary

 

This tweetchat contained many tweets with varying perspectives, here are a few highlights:


QUESTION 1








QUESTION 2









QUESTION 3









QUESTION 4










QUESTION 5










AND FINALLY .....













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@MhnurseDanii92
03 February 2020 23:17
I feel that this was really resourceful, and I know I can openly speak if ever in need. Great tweetchat! Thanks
@Ian_CostelloNA
30 January 2020 22:55
I enjoyed partaking in this tweet chat as this is something that is difficult to discuss and think about. I have also been provided a safe place to talk openly, and I was surprised that many people find this difficult to talk about even though this is a very important path of everyone life journey - end of life and death can be very powerful but should be done with respect, compassion and empathy. Look forward to the next




 #WeNurses transcript

 
@WeNurses
30 January 2020 20:00
Welcome to #WeNurses :) Tonight we are discussing "Learning from deaths" and have the amazing @smillichope & @HeatherStacey7 as guests if you are joining us for the next hour please say "Hi" and let us know your first thoughts regarding learning from deaths https://t.co/8R8WVizRc0
@carolgair
30 January 2020 20:01
@WeNurses @smillichope @HeatherStacey7 Hi, Carol here. Loitering. Might find something useful to say #wenurses
@AgencyNurse
30 January 2020 20:01
Hi there - Teresa here tweeting from Bristol ... first thoughts ... there's lots to learn #WeNurses https://twitter.com/WeNurses/status/1222972984010461190
@WeNurses
30 January 2020 20:02
Hi Heather and welcome :D #WeNurses https://twitter.com/HeatherStacey7/status/1222973271286652928
@SueS4sue
30 January 2020 20:02
@WeNurses @smillichope @HeatherStacey7 Hi all- first thoughts- have we learnt anything from the Francis Report? #WeNurses
@WeNurses
30 January 2020 20:03
Hi Steph - great to have you here #WeNurses https://twitter.com/smillichope/status/1222973289477349377
@WeNurses
30 January 2020 20:03
RT @SueS4sue: @WeNurses @smillichope @HeatherStacey7 Hi all- first thoughts- have we learnt anything from the Francis Report? #WeNurses
@smillichope
30 January 2020 20:03
@AgencyNurse Hi Tree definitely lots to learn and often staff are learning without realising it :) #wenurses
@WeNurses
30 January 2020 20:03
@carolgair @smillichope @HeatherStacey7 @AgencyNurse @SueS4sue welcome to #wenurses folks - thanks for joining!!!
@Louise90999815
30 January 2020 20:04
@smillichope @WeNurses @HeatherStacey7 Hi it’s Louise from Newcastle here??I am interested in death cafes ?? #wenurses
@HeatherStacey7
30 January 2020 20:05
#wenurses Death cafes have been useful to support people to talk about death - both staff and families
@WeNurses
30 January 2020 20:05
It's time to get started with some questions: QUESTION 1 What do you think helps staff talk about death and dying with patients? #WeNurses https://t.co/BdsS4lusoy
@LeaBasra
30 January 2020 20:05
@SueS4sue @WeNurses @smillichope @HeatherStacey7 Im not sure we have still many lessons to be learned and care to be improved #wenurses
@AgencyNurse
30 January 2020 20:05
@smillichope yes indeed - but perhaps we need to get better at not only recognising this but also sharing it #WeNurses
@WeNurses
30 January 2020 20:05
Not joined a tweetchat before? 3 simple steps... 1. Click on > #wenurses < to see the tweets 2. Add > #wenurses < to your tweets to join the chat 3. HAVE FUN LEARNING https://t.co/WoPTySLezt
@Louise90999815
30 January 2020 20:05
@smillichope @WeNurses @HeatherStacey7 I am doing outreach work atm and would like to set one up ??#wenurses
@Ian_CostelloNA
30 January 2020 20:06
@WeNurses @smillichope @HeatherStacey7 Hello all #WeNurses My first experience of death was during my #NursingAssociate training - I was able to learn so much from showing compassion and person-centred care, even during end of life and death. Honour to care for those at the end of the life’s journey
@carolgair
30 January 2020 20:06
@WeNurses Training. Needs a practitioner confident in the discussion. Good support from team to develop skills. Debriefing #wenurses
@WeNurses
30 January 2020 20:06
@LeaBasra @smillichope @HeatherStacey7 welcome to #wenurses Lea :)
@HeatherStacey7
30 January 2020 20:06
#wenurses thanks Ian
@LeaBasra
30 January 2020 20:06
@WeNurses Quiet uninterrupted and not time rushed comfortable environment #wenurses
@AgencyNurse
30 January 2020 20:06
Great first question .... my gut instinct is to say time .... but having thought about this today i think it has more to do with confidence #WeNurses https://twitter.com/WeNurses/status/1222974039578304512
@WeNurses
30 January 2020 20:07
@Louise90999815 @smillichope @HeatherStacey7 hi Louise :) thanks for joining #wenurses this eve!
@thesismum
30 January 2020 20:07
RT @WeNurses: Welcome to #WeNurses :) Tonight we are discussing "Learning from deaths" and have the amazing @smillichope & @HeatherStace…
@RN_Emily_HPN
30 January 2020 20:07
@WeNurses An appropriate environment. #wenurses
@AgencyNurse
30 January 2020 20:07
We perhaps often learn things on an individual level but when ... and indeed where ... do we share that with colleagues ? #WeNurses https://twitter.com/smillichope/status/1222974358844596231
@WeNurses
30 January 2020 20:07
@Ian_CostelloNA @smillichope @HeatherStacey7 hi Ian, lovely to see you on #wenurses again this eve :)
@WeNurses
30 January 2020 20:07
RT @Ian_CostelloNA: @WeNurses @smillichope @HeatherStacey7 Hello all #WeNurses My first experience of death was during my #NursingAssociat…
@SueS4sue
30 January 2020 20:07
@smillichope @WeNurses @HeatherStacey7 Hi Steph I think that is what concerns me- the no. of similarities in big reports #smallchanges #WeNurses
@smillichope
30 January 2020 20:08
@RN_Emily_HPN @WeNurses Hi Emily What would make an appropriate environment in your eyes? #wenurses
@WeNurses
30 January 2020 20:08
@RN_Emily_HPN thanks for participating this eve Emily :) #wenurses
@LoosemoreMarie
30 January 2020 20:08
@WeNurses Experience Empathy and kindness #wenurses
@WeNurses
30 January 2020 20:08
RT @LeaBasra: @WeNurses Quiet uninterrupted and not time rushed comfortable environment #wenurses
@LeaBasra
30 January 2020 20:08
@WeNurses Advanced communication training has helped me massively which was primarily aimed at speaking with the dying and bereaved but i will admit even with this training it still is not easy to do #wenurses
@HeatherStacey7
30 January 2020 20:08
#wenurses shared learning seems to be a real challenge - we often work in silos and think only about our intervention
@AgencyNurse
30 January 2020 20:09
Three really important words here #WeNurses https://twitter.com/LoosemoreMarie/status/1222974827176304641
@ClareFuller17
30 January 2020 20:09
Hi, developing skills to talk about death and dying with patients and their families/carers came for me from: - Learning from others and experience - Advanced Communication Skills education - Interest and self-learning through education #wenurses
@carolgair
30 January 2020 20:09
@WeNurses I did an essential communications course several years ago. Parts were videoed with actors playing patient roles - we played ourselves. Was intense but really really useful. Not only with death and dying, but delivering bad news, supporting grief etc #wenurses
@Louise90999815
30 January 2020 20:09
@HeatherStacey7 @smillichope @WeNurses That would be fab??#wenurses
@SueS4sue
30 January 2020 20:09
@WeNurses Starting the conversation as early as possible #WeNurses
@Ian_CostelloNA
30 January 2020 20:09
RT @WeNurses: @Ian_CostelloNA @smillichope @HeatherStacey7 hi Ian, lovely to see you on #wenurses again this eve :)
@WeNurses
30 January 2020 20:09
Wow that sounds like interesting training .... how / where did you access this ? #WeNurses https://twitter.com/LeaBasra/status/1222974958269272065
@AgencyNurse
30 January 2020 20:09
#WeNurses yes indeed https://twitter.com/smillichope/status/1222975074715734018
@WeNurses
30 January 2020 20:09
Tonight (NOW) We are "learning from deaths" via #wenurses Read the prechat here http://wecommunities.org/tweet-chats/chat-details/5438 or jump right in! https://t.co/vTnwBEdXgg
@HeatherStacey7
30 January 2020 20:10
thanks Lea #wenurses staff have told us they can lack in confidence when talking about death and dying with both patients and families
@Louise90999815
30 January 2020 20:10
RT @WeNurses: Tonight (NOW) We are "learning from deaths" via #wenurses Read the prechat here http://wecommunities.org/tweet-chats/chat-details/5438 or jump right in! htt…
@AgencyNurse
30 January 2020 20:10
Experience helps ... but training and support is key #WeNurses https://twitter.com/smillichope/status/1222975201920659456
@Anna_Chick
30 January 2020 20:10
@WeNurses Confidence and knowing that you have support #wenurses
@WeNurses
30 January 2020 20:10
RT @Anna_Chick: @WeNurses Confidence and knowing that you have support #wenurses
@WeNurses
30 January 2020 20:10
RT @HeatherStacey7: thanks Lea #wenurses staff have told us they can lack in confidence when talking about death and dying with both patien…
@WeNurses
30 January 2020 20:10
@ClareFuller17 thanks for sharing Clare :) #wenurses
@WeNurses
30 January 2020 20:11
#WeNurses https://twitter.com/pea88/status/1222975236901044224
@ClareFuller17
30 January 2020 20:11
@WeNurses Being brave enough to pick up on patient cues, following patient lead #wenurses
@WeNurses
30 January 2020 20:11
@Anna_Chick evening Anna :) thanks for chatting with us all this eve :) #WeNurses
@WeNurses
30 January 2020 20:11
A really good point #WeNurses https://twitter.com/SueS4sue/status/1222975177824317443
@WeNurses
30 January 2020 20:11
#WeNurses https://twitter.com/biglad1/status/1222975055388344320
@LeaBasra
30 January 2020 20:11
@WeNurses I did this as part of palliative and end of life degree i did at local university though the hospice i work at. My local hopsice do traning days open to all health care professionals around communication #wenurses
@HeatherStacey7
30 January 2020 20:12
#wenurses @LoosemoreMarie thanks for that - how do we support people without experience ? Do you think newly qualified and out of hours workers seem more vulnerable ?
@smillichope
30 January 2020 20:12
@AgencyNurse Staff have talked about support a lot during our project and it varies hugely #wenurses
@SueS4sue
30 January 2020 20:12
@WeNurses Working in dementia care if we don't do this our patients may never have the opportunity to express their wishes. Can they have a good planned death if it's never discussed #WeNurses
@WeNurses
30 January 2020 20:12
A really interesting question ... how do we get confident talking about death and dying ? #WeNurses https://twitter.com/RN_Emily_HPN/status/1222975446914125829
@Louise90999815
30 January 2020 20:12
RT @Anna_Chick: @WeNurses Confidence and knowing that you have support #wenurses
@WeNurses
30 January 2020 20:12
RT @HeatherStacey7: #wenurses @LoosemoreMarie thanks for that - how do we support people without experience ? Do you think newly qualifie…
@Ian_CostelloNA
30 January 2020 20:12
@WeNurses #WeNurses Honestly, talking about death for me is difficult as no knows what it’s like. I know one thing for sure, everyone should feel that they are the most important person at the very end. I still talked to the patient after they had passed - hard to discuss though
@RN_Emily_HPN
30 January 2020 20:12
@smillichope @WeNurses I guess it would be different for each individual. The main thing would be no distractions. Whether that be noise, lighting or interruptions. Also, the people there that the person wants there. #WeNurses
@LeaBasra
30 January 2020 20:12
@smillichope @WeNurses Unfortunately not as long as we should. #wenurses
@Anna_Chick
30 January 2020 20:12
@WeNurses Good to be here am trying to collect information for students with @NicolaFielding1 #Wenurses
@WeNurses
30 January 2020 20:12
Good to know - thank you :) #WeNurses https://twitter.com/LeaBasra/status/1222975730465869828
@Louise90999815
30 January 2020 20:13
@Anna_Chick @WeNurses What about the spiritual side of death where do people think this fits in??#wenurses
@RhiannaPunc19
30 January 2020 20:13
@WeNurses Being open and honest about the situation. Also being confident about what you are talking about #wenurses
@WeNurses
30 January 2020 20:13
#wenurses https://twitter.com/nikkilouh/status/1222976104195141633
@HeatherStacey7
30 January 2020 20:14
#wenurses seems that there is a movement to encourage people to talk about death and preferences at all ages and times not just when ill.
@AgencyNurse
30 January 2020 20:14
ooh tricky question .... some of it is training and some of it's support ... also i wonder if some of it is the realisation that the sooner you talk about it the easier it is #WeNurses https://twitter.com/RN_Emily_HPN/status/1222975446914125829
@carolgair
30 January 2020 20:14
Oops, sorry, #wenurses https://twitter.com/carolgair/status/1222976380234801162
@ClareFuller17
30 January 2020 20:14
@smillichope I have done, yes. Feel passionately that good communication is a skill that can be learned & improved (sorry - need to be off line for a bit... but will respond when able....) #wenurses
@WeNurses
30 January 2020 20:14
@nikkilouh @smillichope @HeatherStacey7 thanks for joining and sharing your professional and personal experiences #wenurses
@WeNurses
30 January 2020 20:15
QUESTION 2 What do you think helps staff communicate with bereaved families/carers/friends? #WeNurses https://t.co/IKnMc6En6Q
@Anna_Chick
30 January 2020 20:15
@Louise90999815 @WeNurses It is integral I think but it often gets forgotten but then there is so much to think about #wenurses
@AgencyNurse
30 January 2020 20:15
yes indeed - i think this is a positive move #WeNurses https://twitter.com/HeatherStacey7/status/1222976274907435009
@SueS4sue
30 January 2020 20:15
@HeatherStacey7 @WeNurses @LoosemoreMarie Death is one of the few certainties in life and can't be avoided. It's not about professional experience more about professional boundaries and being human IMO #WeNurses
@WeNurses
30 January 2020 20:15
@carolgair hehe :) #wenurses
@WeNurses
30 January 2020 20:15
#wenurses https://twitter.com/Brayford2Paula/status/1222976453110894592
@DitsyRedOne
30 January 2020 20:16
@WeNurses Support. That could be official training modules, lectures in communication to include the 'warning shot', motivational interviewing, active listening and body language. It will hopefully involve a wealth of experience as student and junior staff observing seniors (1/2) #WeNurses
@RN_Emily_HPN
30 January 2020 20:16
@AgencyNurse I also think that it's important to be honest and accept that sometimes we don't have all the answers but be confident that we will do the best we can do for that person and their family. #wenurses
@AgencyNurse
30 January 2020 20:16
Yes can relate to this .... though "support" isn;t always formal ... a great team goes a long way #WeNurses https://twitter.com/smillichope/status/1222975840402710532
@AgencyNurse
30 January 2020 20:16
nicely said #WeNurses https://twitter.com/RN_Emily_HPN/status/1222976851221663744
@carolgair
30 January 2020 20:16
@WeNurses Trust. Clarity. Honesty #wenurses
@HeatherStacey7
30 January 2020 20:16
#wenurses is there something about second and third conversations - offering time to talk and re visiting this ?
@WeNurses
30 January 2020 20:16
Another interesting question #WeNurses https://twitter.com/Louise90999815/status/1222976073371148288
@smillichope
30 January 2020 20:17
@SueS4sue @HeatherStacey7 @WeNurses @LoosemoreMarie Do you think some staff find it easier than others? Should all staff have training to enable these confidence and skills? #wenurses
@SueS4sue
30 January 2020 20:17
@carolgair @WeNurses So is that then about the patient, the family or staff? Is it about different care providers being involved? #WeNurses
@WeNurses
30 January 2020 20:17
Thanks for sharing Nikki and welcome #WeNurses https://twitter.com/nikkilouh/status/1222976104195141633
@Anna_Chick
30 January 2020 20:17
@carolgair @WeNurses Good answer #wenurses
@WeNurses
30 January 2020 20:17
RT @RhiannaPunc19: @WeNurses Being open and honest about the situation. Also being confident about what you are talking about #wenurses
@LeaBasra
30 January 2020 20:17
@AgencyNurse Defo agree with confidence But do we ever get fully confident Iv had these type of convos lots of times and i still dont feel confident in having them I also think my fear in how the pt will react hiders that but how am i expecting the pt to react not happy most of time #wenurses
@Louise90999815
30 January 2020 20:17
RT @RhiannaPunc19: @WeNurses Being open and honest about the situation. Also being confident about what you are talking about #wenurses
@WeNurses
30 January 2020 20:17
#WeNurses https://twitter.com/smillichope/status/1222976227214077953
@nikkilouh
30 January 2020 20:17
@WeNurses #Wenurses empathy , understanding of the patients wishes .
@WeNurses
30 January 2020 20:18
#WeNurses https://twitter.com/carolgair/status/1222976380234801162
@WeNurses
30 January 2020 20:18
#WeNurses https://twitter.com/Brayford2Paula/status/1222976453110894592
@WeNurses
30 January 2020 20:18
#WeNurses https://twitter.com/smillichope/status/1222976504382021633
@Ian_CostelloNA
30 January 2020 20:18
@WeNurses #WeNurses - this is something that can’t really be taught. I worried that if I was anxious I would seem like I was hiding something. I didn’t want to be confident because it would have appeared as though I didn’t care.... I wasn’t afraid of showing my emotion though
@DitsyRedOne
30 January 2020 20:18
@WeNurses Once observed, guided reflection and coaching followed by supervised practice with senior staff can build knowledge, competence and confidence. Scared staff block and avoid conversations to the huge detriment of patients, possibly denying them a chance at a good death #WeNurses
@smillichope
30 January 2020 20:18
@RN_Emily_HPN @AgencyNurse really nice answer and not always an easy thing to do #wenurses
@Ian_CostelloNA
30 January 2020 20:18
RT @WeNurses: QUESTION 2 What do you think helps staff communicate with bereaved families/carers/friends? #WeNurses https://t.co/IKnMc6En…
@HeatherStacey7
30 January 2020 20:19
#wenurses We spoke to chaplains about supporting the spiritual needs
@SueS4sue
30 January 2020 20:19
@smillichope @HeatherStacey7 @WeNurses @LoosemoreMarie I do think that some find it easier than others. I have a specific interest in EoL care but some colleagues avoid it #WeNurses
@XMcVey
30 January 2020 20:19
@WeNurses Having the right space and time to speak with everyone helps. I never want families to feel rushed or feel the sometimes chaos of the environment around them when talking about dying #wenurses
@NRCUK
30 January 2020 20:19
@WeNurses Demonstrating the value - i know so few settings that proactively look to record deaths meaningfully to learn from. Had a friend that took over a year to create a view of who died of what and when in their hospital that year, there is no culture of learning :( #wenurses
@Ian_CostelloNA
30 January 2020 20:19
@carolgair @WeNurses #WeNurses / agreed with you Carol
@AgencyNurse
30 January 2020 20:20
@LeaBasra so perhaps some recognition that this is difficult ! And sometimes more difficult than others ... circumstances, personalities, environment all have a role to play here re our confidence #WeNurses
@SamSpence01
30 January 2020 20:20
#wenurses Very much this, it’s making the conversations normal in everyday life. Not much happens to us all, dying is one of the things that will. https://twitter.com/heatherstacey7/status/1222976274907435009
@carolgair
30 January 2020 20:20
@SueS4sue @WeNurses In this case, the staff I think. Was long term unit, stable staff turnover. Known wishes and plan of care. All got turned on it’s head when the moment came. #wenurses
@HeatherStacey7
30 January 2020 20:20
@clairgair #wenurses I agree fear can sometimes result in actions that do not always match the wishes of the person
@RhiannaPunc19
30 January 2020 20:20
@WeNurses Empathy #wenurses
@Anna_Chick
30 January 2020 20:20
@smillichope @WeNurses @PlymUni #wenurses
@SueS4sue
30 January 2020 20:20
@RhiannaPunc19 @WeNurses Even as a professional it's okay to express emotion #ItsOkNotToBeOk #itsOkaytocry #WeNurses
@nikkilouh
30 January 2020 20:21
@WeNurses I suppose you have to react to each situation different according to how families want to grieve . E.g active listening , making a drink , discussing their wishes etc . I guess you have to be aware of different ways of communication. #wenurses
@NRCUK
30 January 2020 20:21
#WeNurses https://twitter.com/smillichope/status/1222978120128528384
@SamSpence01
30 January 2020 20:21
@WeNurses I would suggest sometimes it’s less about the talking and more about the listening. #wenurses
@smillichope
30 January 2020 20:22
@NRCUK oops #wenurses
@Louise90999815
30 January 2020 20:22
@Anna_Chick @smillichope @WeNurses @PlymUni #wenurses
@SueS4sue
30 January 2020 20:22
@carolgair @WeNurses I find that really sad when a plan is made. Was fear from recent NMC cases an influence? #WeNurses
@HeatherStacey7
30 January 2020 20:22
@JOP691 thanks - tender is a lovely way to describe the conversations #wenurses
@AgencyNurse
30 January 2020 20:22
@Ian_CostelloNA @WeNurses really good points Ian .. not sure if I agree I think we can teach this .... perhaps though (as with many learning journeys) it takes time to learn #WeNurses 1/2
@carolgair
30 January 2020 20:22
@SueS4sue @WeNurses Just to add, the impact was pretty devastating. Was quite distressing although that was not the intention #wenurses
@Ian_CostelloNA
30 January 2020 20:23
@smillichope @WeNurses #WeNurses absolutely agree with the different approach with every situation. Displaying the values that you would expect and those by the @nmcnews helps. Oh and always nonjudgemental regardless of the causation - lifestyle choice or other
@AgencyNurse
30 January 2020 20:23
@Ian_CostelloNA @WeNurses 2/2 also i when i think back to how i learnt this some of it was through theory but sooooo much of it was through really good role models #WeNurses
@Louise90999815
30 January 2020 20:23
@NRCUK @WeNurses Especially for LD clients where life span is limited and some conditions lead to death unnecessarily ??#wenurses
@AgencyNurse
30 January 2020 20:23
@Ian_CostelloNA @WeNurses PS sorry to disagree ! ;D #WeNurses
@DitsyRedOne
30 January 2020 20:24
@WeNurses Clear guidance via policies. Knowing it's ok to say you don't have the answers but will do your best to get them. Full knowledge of local availability to signpost or aid access. Ability to explain in laymans terms and check understanding. Confidence to allow silence. #WeNurses
@HeatherStacey7
30 January 2020 20:24
@carolgair - sorry to hear that - has an impact for all involved when wishes are not respected #WeNurses
@Anna_Chick
30 January 2020 20:24
@Louise90999815 @smillichope @WeNurses @PlymUni No we don’t have trips to the morgue students can do this on placement and meet with staff - never thought of speaking with funeral directors such a good idea they have so much skill in this area #wenurses
@WeNurses
30 January 2020 20:24
Is this always possible ?? How could we get better at this ? #WeNurses https://twitter.com/XMcVey/status/1222977668913778689
@NRCUK
30 January 2020 20:24
@smillichope @WeNurses Good luck - first step clearly is wanting to improve and learn, seems really odd that this isn't monitored really, really closely to look at variations from benchmark. It is for young and LD vulnerable but nothing in between > NHS is do no harm < death is pretty harmy! #wenurses
@WeNurses
30 January 2020 20:25
RT @SamSpence01: #wenurses Very much this, it’s making the conversations normal in everyday life. Not much happens to us all, dying is one…
@WeNurses
30 January 2020 20:25
QUESTION 3 Tell us about what helped you develop or learn skills to talk about death and dying with patients and their families/carers... #WeNurses https://t.co/52ilxXGSzj
@XMcVey
30 January 2020 20:25
@AgencyNurse @Ian_CostelloNA @WeNurses I think this is such a good point. I was taught some great tools but in practice I have learnt the most from working with some superb nurses and doctors who weren’t frightened to have those difficult conversations #wenurses
@Lerounxi
30 January 2020 20:25
@WeNurses Understanding that you’re probably dealing with a family/friend/relative that is going through one of the darkest times of their life. Using the skills we have to be able to react to body language, tone of voice and appropriateness of asking and responding to questions #WeNurses
@carolgair
30 January 2020 20:25
@SueS4sue @WeNurses This was my mum in 2018. Early onset Alzheimer’s - #NOF, which we didn’t fix as had agreed Ward ceiling. PE after 12wks bed rest. Came into O2 and dynamaps and fans and windows open for active cooling. And steep bed tilt on unfixed hip. #wenurses
@SamSpence01
30 January 2020 20:25
@SueS4sue @RhiannaPunc19 @WeNurses So much this, my first unexpected child death hit me hard and I was in tears at the same time as supporting the family as best I could. Generally though if you’re with the family and more upset than them it might be good to get a colleague to step in #wenurses
@SueS4sue
30 January 2020 20:25
@WeNurses Empathy, understanding, emotion and time #WeNurses
@AgencyNurse
30 January 2020 20:25
I think so too #WeNurses https://twitter.com/SueS4sue/status/1222978029581934592
@SofiaSportelli
30 January 2020 20:25
#WeNurses I think empathy plays a big role. Be able to understand how a person might feel in that moment is the key to effective communication in such delicate times. Experience can also help, either personal or professional, it can help to connect with patient.
@Ian_CostelloNA
30 January 2020 20:25
@AgencyNurse @WeNurses #WeNurses in practice yes but hard in role play and simulation. It is really something I had to learn with a mentor who took the time to really provide support and also a safe place to debrief afterwards - if that makes sense
@Louise90999815
30 January 2020 20:25
@Anna_Chick @smillichope @WeNurses @PlymUni May be useful to go to crematorium to experience what happens there??#wenurses
@nikkilouh
30 January 2020 20:26
@smillichope @WeNurses In university we do communication workshops: I think the trust offers training in end of life care for NQN and year 3 students. I would think face to face will be better . #wenurses
@carolgair
30 January 2020 20:26
@smillichope @SueS4sue @WeNurses Sorry, no we were relatives on this occasion. #wenurses
@AgencyNurse
30 January 2020 20:26
I like this point .. acts of kindness at tough times go a long way #WeNurses https://twitter.com/nikkilouh/status/1222978074528100352
@Ian_CostelloNA
30 January 2020 20:26
@AgencyNurse @WeNurses Why sorry? This is exactly what helps me learn and develop @AgencyNurse #WeNurses - safe place to discuss and learn ????
@Louise90999815
30 January 2020 20:26
@WeNurses There are some good books on death and dying #kublerross #wenurses
@NRCUK
30 January 2020 20:26
@Louise90999815 @WeNurses problem you have is you are using a negative to drive a positive and the NHS will run away from anything that highlights any potential negative, even if they are aware of existing harm... hence CDOP and LeDeR for vulnerable #WeNurses
@SueS4sue
30 January 2020 20:27
@WeNurses I'm struggling to get training because of job role but also cos of personal bereavement and expected bereavement #WeNurses
@HeatherStacey7
30 January 2020 20:27
@XMcVey #WeNurses the environment can make a real difference cant it ? People often speak about lack of space and privacy
@LeaBasra
30 January 2020 20:27
@WeNurses Similar stuff thats has already been said for q1 but it also helps if family ect are ready to accept the news you are sharing with them. Family that are in denial are much more harder to have open honest difficult conversations with #wenurses
@SamSpence01
30 January 2020 20:27
@WeNurses It’s prioritising those conversations and that time. I think lack of time is sometimes an excuse because it’s a conversation many find hard to have #WeNurses @XMcVey
@Anna_Chick
30 January 2020 20:27
@WeNurses I have learnt everything from colleagues in all professions particularly in PICU where these conversations happened on a daily basis #wenurses
@Ian_CostelloNA
30 January 2020 20:27
@smillichope @DitsyRedOne @WeNurses #WeNurses - silence can be so powerful
@carolgair
30 January 2020 20:27
@WeNurses Exposure. Like any skill. Reflection. Humility. #wenurses
@SueS4sue
30 January 2020 20:28
@carolgair @smillichope @WeNurses Being a relative in these situations is harder especially when you can see the nurses perspective #WeNurses
@AgencyNurse
30 January 2020 20:28
@Ian_CostelloNA @WeNurses yes absolutely it does .... it's the difference between injecting an orange (not sure they still do that now) and injecting a real person ! #WeNurses
@Lerounxi
30 January 2020 20:28
@WeNurses “Don’t beat it round the bush” Be honest with whoever you’re speaking with. Using direct language such as ‘died’ rather than ‘gone’ it helps whoever receiving this sad news understand situation without creating confusion. #WeNurses
@NRCUK
30 January 2020 20:28
#WeNurses #WeNurses #WeNurses Lots of amazing views and experiences coming through :) remember to add #wenurses so everyone following the # sees them :) #WeNurses #WeNurses #WeNurses
@WeNurses
30 January 2020 20:29
#WeNurses #WeNurses #WeNurses Lots of amazing views and experiences coming through :) remember to add #wenurses so everyone following the # sees them :) #WeNurses #WeNurses #WeNurses
@SueS4sue
30 January 2020 20:29
RT @WeNurses: #WeNurses #WeNurses #WeNurses Lots of amazing views and experiences coming through :) remember to add #wenurses so everyone f…
@carolgair
30 January 2020 20:29
@XMcVey @AgencyNurse @Ian_CostelloNA @WeNurses Palliative care nurses are some of the most amazing people around #wenurses ?? them
@Louise90999815
30 January 2020 20:29
RT @WeNurses: #WeNurses #WeNurses #WeNurses Lots of amazing views and experiences coming through :) remember to add #wenurses so everyone f…
@LeaBasra
30 January 2020 20:29
@WeNurses The thing that helped me the most has been communication training that focused on difficult conversations but even with this training it is not easy or nice to have these convos sometimes they go well other times they go wrong so reflect on why to learn how to do better #wenurses
@ClareFuller17
30 January 2020 20:30
@WeNurses Understanding that talking to won't make the situation worse and by assessing level of understanding first by skilled questions = understanding Perception in SPIKES framework #wenurses
@smillichope
30 January 2020 20:30
@carolgair @XMcVey @AgencyNurse @Ian_CostelloNA @WeNurses do other staff groups rely on them to break bad news or have those difficult conversations? #wenurses
@Ian_CostelloNA
30 January 2020 20:30
@NRCUK #WeNurses - I think I am getting better at this now ??
@HeatherStacey7
30 January 2020 20:30
@carolgair #WeNurses Palliative care and EOLC settings are often seen as the experts - how can we learn from them ?
@SamSpence01
30 January 2020 20:30
@Anna_Chick @WeNurses @Louise90999815 @smillichope @PlymUni I lived with a funeral director, they are definitely worth speaking to and learning from. The same as seeing those who have died away from a clinical setting... #wenurses
@smillichope
30 January 2020 20:30
@Ian_CostelloNA @NRCUK me too #wenurses!!!!!
@AgencyNurse
30 January 2020 20:30
@XMcVey @Ian_CostelloNA @WeNurses i have too .... sometimes i even see myself doing the things i saw really great nurses / mentors do years ago ... taking the best and passing it on #WeNurses
@nikkilouh
30 January 2020 20:30
@WeNurses For Children and adults on a personal level I have used the book ‘ Badgers parting gift’ . #wenurses
@XMcVey
30 January 2020 20:30
@SamSpence01 @WeNurses Yes some of the most difficult conversations I’ve had have been when juggling incoming patients in ED but you’re right prioritising is so important. the longer people wait the worse they feel and time must just feel endless for them waiting for news #wenurses
@AgencyNurse
30 January 2020 20:30
@Ian_CostelloNA @WeNurses ;D #WeNurses
@NRCUK
30 January 2020 20:31
@Louise90999815 @WeNurses @PaulaMc007 you don't loads of research, you just have to be in the system for 30 seconds and look for ways to help improve quality and efficiency for staff and patients and you see very quickly what they don't want to know! :( #willfulblindness #wenurses
@AgencyNurse
30 January 2020 20:31
@Ian_CostelloNA @WeNurses #showingmyage #WeNurses
@hepworth_becky
30 January 2020 20:31
@WeNurses Joining late I’m afraid. Sorry! I think experience and following the example of good role models gave me the confidence to talk openly about death. #wenurses
@RhiannaPunc19
30 January 2020 20:31
@WeNurses Exposure and learning from other colleagues. As a HCA/SN, I have observed many nurses have the conversation sadly :( #wenurses
@Anna_Chick
30 January 2020 20:31
@smillichope @WeNurses Yes and no because I am always surprised by reactions and have learnt to never underestimate how much a family can teach me #wenurses
@Lerounxi
30 January 2020 20:32
@WeNurses Listening & sitting in on conversations whilst I was a student and dealing with my first patient death as a registered nurse. Learning from these experiences builds confidence, understanding which will display itself in the way you deliver in these difficult situations #WeNurses
@NRCUK
30 January 2020 20:32
@smillichope @Ian_CostelloNA no you aren't, lol, up your #wenurses game Steph :) :) :) Lots for you to take in this eve though :)
@WeNurses
30 January 2020 20:32
A really great point Sofia #WeNurses https://twitter.com/SofiaSportelli/status/1222979214862880769
@carolgair
30 January 2020 20:32
@smillichope @XMcVey @AgencyNurse @Ian_CostelloNA @WeNurses Yes, I think that’s probably true. Having information is important. Not always know on ward. #wenurses
@DitsyRedOne
30 January 2020 20:32
@WeNurses Practice. Experience (both work based and as a relative of a dying patient, the latter changed my practice due to deeper understanding of the relentless pressures on family). Motivational interviewing to help them express the unexpressable. Group reflection. #WeNurses
@LeaBasra
30 January 2020 20:32
@smillichope @Anna_Chick @WeNurses I dont think it gets easier you just learn how to be more compassionate the more you do it best thing is dont shy away be honest and use language that cant be interperted any other way eg they have gone. Urm gone where #wenurses
@WeNurses
30 January 2020 20:32
Any recommendations ? #WeNurses https://twitter.com/Louise90999815/status/1222979509038784514
@Louise90999815
30 January 2020 20:33
@DitsyRedOne @WeNurses Silent and listen have the same letters??#wenurses we need to listen more??
@hepworth_becky
30 January 2020 20:33
@WeNurses Having a tool kit of answers/conversation starters is also useful #wenurses
@WeNurses
30 January 2020 20:33
how do people feel about this ?? #WeNurses https://twitter.com/HeatherStacey7/status/1222979604153085952
@XMcVey
30 January 2020 20:33
@WeNurses Exposure to those situations and a supportive team who helped me manage and articulate my own emotions before/after speaking to patients and their relatives or friends #wenurses
@AgencyNurse
30 January 2020 20:34
@Anna_Chick @WeNurses gosh now that is an incredibly hard conversation ! #WeNurses
@DitsyRedOne
30 January 2020 20:35
@Ian_CostelloNA @smillichope @WeNurses Correct on all counts. During my SPQDN degree we did role play for motivational interviewing. Powerful display of every nurse's innate need to 'fix' things. Frequently unintentionally blocking patient conversation by trying to offer a fix for the first thing they say. #WeNurses
@WeNurses
30 January 2020 20:35
QUESTION 4 What support do you receive at work when there is a death? #WeNurses https://t.co/SlgkEJZva4
@Ian_CostelloNA
30 January 2020 20:35
@WeNurses #WeNurses we often look at these when using safewards ‘bad news mitigation’ it’s for MH wards but it covers space, time, wording, and other important elements of breaking bad news
@hepworth_becky
30 January 2020 20:35
@smillichope @WeNurses Not an official one, more things that have helped in past situations. #wenurses
@SueS4sue
30 January 2020 20:35
@WeNurses I agree, people need to feel comfortable and not rushed. Not in an office with constant interruptions and not at a bedside where all can hear #WeNurses
@WeNurses
30 January 2020 20:35
Excellent question ... #WeNurses https://twitter.com/HeatherStacey7/status/1222980419408355330
@HeatherStacey7
30 January 2020 20:36
@XMcVey #WeNurses is there always time to manage our own emotions before supporting families ?
@WeNurses
30 January 2020 20:36
Thank you for sharing #WeNurses https://twitter.com/nikkilouh/status/1222980474471165952
@SueS4sue
30 January 2020 20:36
@WeNurses Very little apart from colleagues who are friends #WeNurses
@NRCUK
30 January 2020 20:36
@smillichope @ClareFuller17 @WeNurses here you go http://www.cetl.org.uk/learning/feedback_opportunities/data/downloads/breaking_bad_news.pdf SPIKES - The Six-Step Protocol for Delivering Bad News - CETL #WeNurses
@AgencyNurse
30 January 2020 20:36
I like this piece of advice #WeNurses https://twitter.com/XMcVey/status/1222981760021037061
@receivingconsnt
30 January 2020 20:36
RT @AgencyNurse: I like this piece of advice #WeNurses
@WeNurses
30 January 2020 20:37
@hepworth_becky thanks for joining and sharing Becky :) #wenurses
@carolgair
30 January 2020 20:37
@HeatherStacey7 I can see why it happened. It just felt like further torture. Albeit the intention was good. Perhaps reflexive due to the acute event. #wenurses
@Ian_CostelloNA
30 January 2020 20:37
@WeNurses #WeNurses - learning form compassionate registered nurses that take the time to explain and support other professionals through this. Along with good reflection
@Anna_Chick
30 January 2020 20:37
@AgencyNurse @WeNurses Always so hard because parents would say to me ‘ what would you do?’ and I was always lost for words #wenurses
@Ian_CostelloNA
30 January 2020 20:37
RT @WeNurses: QUESTION 4 What support do you receive at work when there is a death? #WeNurses https://t.co/SlgkEJZva4
@WeNurses
30 January 2020 20:37
ooh interesting ... anyone else have this ?? #WeNurses https://twitter.com/hepworth_becky/status/1222981100236169217
@HeatherStacey7
30 January 2020 20:37
#WeNurses do you get support when someone dies , or is it seen as "part of the job" and you need to manage this ?
@WeNurses
30 January 2020 20:37
good question.... #wenurses https://twitter.com/HeatherStacey7/status/1222981812806397953
@receivingconsnt
30 January 2020 20:37
@XMcVey @WeNurses Yes same here. Not to use terms that may be misinterpreted ‘passed away’ ‘moved in’ ‘slipped away’ it’s too important a conversation to risk euphemisms #WeNurses
@Anna_Chick
30 January 2020 20:38
@WeNurses No but I love a tool kit #wenurses
@nikkilouh
30 January 2020 20:38
@WeNurses I have not experienced this yet . #Wenurses
@SamSpence01
30 January 2020 20:38
@WeNurses Not avoiding the conversations/getting colleagues to take the lead. It’s using the same skills nurses use in much of their practice in a different context #wenurses
@Ian_CostelloNA
30 January 2020 20:38
@WeNurses #WeNurses luckily I have always been supported by a mentor and also the university when this happened to me. However, I look forward to reading other people’s support to learn from
@LeaBasra
30 January 2020 20:38
@WeNurses In the hospice i work at we are luckily to have fab support from our multi-professional team who have done debreifs, clinical supervision even counselling if needed. Other than that the support from your nursing colleagues can go a long way #wenurses
@AgencyNurse
30 January 2020 20:38
@Anna_Chick @WeNurses oh goodness thats heartbreaking ! Is there lots of support in places like PICU for staff ?? #WeNurses
@XMcVey
30 January 2020 20:39
@HeatherStacey7 That’s a fair point and I have been caught by that before when I’ve felt overwhelmed or really shocked by deaths I have been involved in. I’m fortunate that I’ve worked with colleagues who are ready to step in if needed #wenurses
@WeNurses
30 January 2020 20:39
This is really great to hear #WeNurses https://twitter.com/LeaBasra/status/1222982542804037633
@WeNurses
30 January 2020 20:39
#WeNurses https://twitter.com/DitsyRedOne/status/1222982693991985160
@SueS4sue
30 January 2020 20:39
@smillichope @WeNurses Time and understanding. Space to think and process. Discussion and recognition. Death affects us all in some way. Some are okay but others will be different because of the involvement we've had or the circumstances #WeNurses
@HeatherStacey7
30 January 2020 20:40
@receivingconsnt #WeNurses agree - need to be clear - "sick enough to die" is one suggestion
@Ian_CostelloNA
30 January 2020 20:40
@LeaBasra @WeNurses #WeNurses - like a debrief and or post incident SWARM?
@LeaBasra
30 January 2020 20:40
@WeNurses When i worked in a hospital other than colleagues support was none existent #wenurses
@carolgair
30 January 2020 20:40
@WeNurses We support colleagues, reflect on the circumstances. Offer support. We give a little moment of silence to honour them. #wenurses
@ClareFuller17
30 January 2020 20:40
@NRCUK @smillichope @WeNurses Cheers - yes it is a great help. Understanding the Perception element allows you to know how to lead the next stages of conversation #wenurses
@HeatherStacey7
30 January 2020 20:41
anyone use a reflective tool to support learning and staff wellbeing ? #WeNurses
@hepworth_becky
30 January 2020 20:41
@LeaBasra @smillichope @Anna_Chick @WeNurses Directness is essential especially when working with children. They always ask things very directly.... #wenurses
@LeaBasra
30 January 2020 20:41
@Ian_CostelloNA @WeNurses Not heard of SWARM before whats that. We do debrief look at what went well what could have gone better. #wenurses
@AgencyNurse
30 January 2020 20:41
@SueS4sue @WeNurses I was thinking the same .... but colleagues can be an excellent form of support! From a hug to making it ok to take a break and everything else inbetween #WeNurses
@WeNurses
30 January 2020 20:42
Are there any reflective tools out there? #wenurses What are you using? https://twitter.com/HeatherStacey7/status/1222983128161144837
@follyfoot5
30 January 2020 20:42
@WeNurses #wenurses Had this conversation today due to an unexpected death (child) ... sadly we don’t get enough support through supervision but following that conversation with our MDT this is going to happen more... plans being put in place ?
@SueS4sue
30 January 2020 20:42
@WeNurses I remember when the LCP was introduced which was a great concept but misused by some? #WeNurses
@XMcVey
30 January 2020 20:42
@WeNurses I think informally the teams I’ve worked in have been great at supporting one another. But I’ve had shifts in ED where I’ve managed multiple deaths in a shift and that’s incredible challenging. We try and debrief when we can #wenurses
@AgencyNurse
30 January 2020 20:42
@HeatherStacey7 I have never been made to feel like "it's part of the job" but have also never had formal support ... always informal from colleagues #WeNurses
@HeatherStacey7
30 January 2020 20:42
@LeaBasra #WeNurses sorry to hear that
@DitsyRedOne
30 January 2020 20:43
@WeNurses I'm a District Nurse and our teams care for patients who choose to die at home every day. They quickly become skilled at ACP and bereavement with the support and training on offer and we always debrief as a team. We also have access to psychological support monthly. #WeNurses
@smillichope
30 January 2020 20:43
@follyfoot5 @WeNurses Hi Sharon Thanks for joining tonight. Thats great that things are going to change and support put in place. It is so important that staff are supported at difficult times. #wenurses
@XMcVey
30 January 2020 20:44
@AgencyNurse @SueS4sue @WeNurses Yes I love the colleague that walks in and forces you to take the break you didn’t know you needed. That permission to breathe and take some space always helps me #wenurses
@emmaloufrain
30 January 2020 20:44
@WeNurses #wenurses we offer clinical supervision to our specialist palliative care nurses which is fabulous however high on the agenda is how we support our wider service ie district nurses, carers etc. Definitely more work needed in this area. Time to debrief is precious!
@Anna_Chick
30 January 2020 20:44
@AgencyNurse @WeNurses Yes we had good support but often little time before the next patient came through the door, I was so shell shocked one day when my patient had passed away suddenly that I told the consultant I was in love with him..... #wenurses #cringemoment
@SueS4sue
30 January 2020 20:44
@AgencyNurse @WeNurses All of my team know how to reduce my stress levels and it usually involves caffeine or chocolate #WeNurses
@Anna_Chick
30 January 2020 20:44
@AgencyNurse @WeNurses Disclaimer : I wasn’t ! #wenurses
@HeatherStacey7
30 January 2020 20:44
@XMcVey #WeNurses we heard that debriefs are hard to do when busy and often only took place after very unexpected or traumatic deaths .
@smillichope
30 January 2020 20:44
@DitsyRedOne @WeNurses thats great to hear Shannon. It sounds like your teams have a good support network #wenurses
@WeNurses
30 January 2020 20:45
QUESTION 5 How does resilience relate to your ability to care for patients/families and carers around the time of death? #WeNurses https://t.co/EWDvf4Zbaz
@SueMarsden6
30 January 2020 20:45
#wenurses https://twitter.com/suemarsden6/status/1222984026144804864
@AgencyNurse
30 January 2020 20:45
@XMcVey @SueS4sue @WeNurses yes indeed some of the most supportive words in nursing are "go and take a break" #Wenurses
@WeNurses
30 January 2020 20:45
#wenurses https://twitter.com/SueMarsden6/status/1222984026144804864
@Ian_CostelloNA
30 January 2020 20:45
@LeaBasra @WeNurses #WeNurses it’s like a swarm of bees getting together and going over everything - like a safety huddle
@AgencyNurse
30 January 2020 20:45
@Anna_Chick @WeNurses oh goodness .... don't tell me you are now married to him !!! #WeNurses
@XMcVey
30 January 2020 20:46
@HeatherStacey7 Debriefs definitely aren’t prioritised enough. I have found after traumas they’re better and more likely to happen. but often can happen without nurses as we set up ready for the next incoming patient sometimes #wenurses
@HeatherStacey7
30 January 2020 20:46
#WeNurses Permission to take space, 5 minutes or admit that you are not ok is essential
@AgencyNurse
30 January 2020 20:46
@Anna_Chick @WeNurses lol ok so maybe you din't marry him then ! #WeNurses
@hepworth_becky
30 January 2020 20:46
@AgencyNurse @Anna_Chick @WeNurses In my experience we are very good in paediatric at supporting each other. Always so very sad and very difficult conversations for all concerned. #wenurses
@WeNurses
30 January 2020 20:47
#wenurses https://twitter.com/DitsyRedOne/status/1222984346388353024
@ClareFuller17
30 January 2020 20:47
@WeNurses Have been involved in Schwartz Rounds - these are brilliant https://www.pointofcarefoundation.org.uk/our-work/schwartz-rounds/about-schwartz-rounds/ #wenurses
@carolgair
30 January 2020 20:47
@WeNurses Hmm. Resilience is a tricky word. Developing coping mechanisms to stress and distress is part of nursing. Resilience is personal to the other stresses and strains in life and isn’t enough on own. Good organisational support needed #wenurses
@HeatherStacey7
30 January 2020 20:47
hard to juggle the pressure of bed flow and take time to reflect and look after each other #WeNurses
@AgencyNurse
30 January 2020 20:47
No i don't think so ... but many of the deaths i see are expected. I think we perhaps need to empower nurses to be able to ask for support when they feel they need it around deaths ... i like to think i would ask #WeNurses https://twitter.com/smillichope/status/1222984357872390144
@Anna_Chick
30 January 2020 20:48
@AgencyNurse @WeNurses No but he was very nice ??#wenurses
@Ian_CostelloNA
30 January 2020 20:48
@WeNurses #WeNurses resilience can be good and also not so good Good because you can break news and deal with this is the best way possible and promote the best cars for the patients family and friends but not so good if resilience results in being desensitised (if that’s possible)
@SueMarsden6
30 January 2020 20:48
@WeNurses #weNurses. For me resilience is being able to cry, then celebrate a life, be proud of what our team, carers etc achieved for the person and then move on because there is always someone else. Resilience is challenging when you get “stuck” in an unresolved death.
@AgencyNurse
30 January 2020 20:48
@Anna_Chick @WeNurses ;D #WeNurses
@WeNurses
30 January 2020 20:48
#WeNurses https://twitter.com/smillichope/status/1222984783954948098
@HeatherStacey7
30 January 2020 20:48
we know that all staff are coping with their own issues and grief - worrying about family and colleagues as well as the people they are caring for - hard to do all of this all of the time #WeNurses
@LeaBasra
30 January 2020 20:49
?? this #wenurses https://twitter.com/ian_costellona/status/1222984848454955025
@WeNurses
30 January 2020 20:49
RT @Ian_CostelloNA: @WeNurses #WeNurses resilience can be good and also not so good Good because you can break news and deal with this is…
@Ian_CostelloNA
30 January 2020 20:49
RT @LeaBasra: ?? this #wenurses
@Penny69298983
30 January 2020 20:49
RT @WeNurses: Are there any reflective tools out there? #wenurses What are you using?
@SueMarsden6
30 January 2020 20:49
@WeNurses #wenurses I don’t use a formal reflective tool unless I’ve got “stuck” on a death and then I think I’d resort to Gibbs!!
@AgencyNurse
30 January 2020 20:50
@hepworth_becky @Anna_Chick @WeNurses It's during conversations like these when i am in awe of you fab CYP nurses ... and glad i chose older peoples nursing #WeNurses
@Ian_CostelloNA
30 January 2020 20:50
@WeNurses *Care not car #WeNurses
@AgencyNurse
30 January 2020 20:50
Yep this #WeNurses https://twitter.com/carolgair/status/1222984683732054021
@hepworth_becky
30 January 2020 20:50
@Anna_Chick @AgencyNurse @WeNurses Funny! #wenurses
@smillichope
30 January 2020 20:50
@AgencyNurse @hepworth_becky @Anna_Chick @WeNurses totally agree!#wenurses
@DitsyRedOne
30 January 2020 20:51
@smillichope @WeNurses We do all EOL care in community, including syringe drivers + have a fantastic team of Community Palliative specialist for complex issues/symptoms. We also have 24 hour palliative team who visit overnight if needed and support OOH by phone for staff and patients. #WeNurses
@SueS4sue
30 January 2020 20:51
@Ian_CostelloNA @WeNurses I agree but if someone is not sensitive and able to display empathy should they be involved in these conversations? #professionalboundaries #WeNurses
@SueMarsden6
30 January 2020 20:51
@smillichope @WeNurses #wenurses. Gosh yes. I cried in a posthumous safeguarding meeting once when I recalled hearing my patient screaming in distress at the other end of the phone as her care home hoisted her with a grade 4 pressure sore. Still haven’t got over that... 8 years later
@jeanleo999
30 January 2020 20:51
@WeNurses Hi #WeNurses supporting the families of the dying I always felt needed respect as well as compassion. You can’t really show either without having honesty throughout those difficult conversations. Every family I’ve supported as a nurse and prior to this a HCSW has welcomed this.
@AgencyNurse
30 January 2020 20:51
I have to say that tonights #WeNurses is sooooo interesting ... there are so many different perspective on the tweetchat ... lots to reflect on #WeNurses
@WeNurses
30 January 2020 20:52
RT @jeanleo999: @WeNurses Hi #WeNurses supporting the families of the dying I always felt needed respect as well as compassion. You can’t r…
@WeNurses
30 January 2020 20:52
A really excellent point Jean #WeNurses https://twitter.com/jeanleo999/status/1222985783751204864
@WeNurses
30 January 2020 20:52
@jeanleo999 thanks for sharing Jean :) #wenurses
@WeNurses
30 January 2020 20:52
#WeNurses https://twitter.com/smillichope/status/1222985861761052688
@WeNurses
30 January 2020 20:52
#WeNurses https://twitter.com/amhay70/status/1222985990203113474
@SueMarsden6
30 January 2020 20:53
@smillichope @WeNurses #wenurses. Yes and in my field (LD) 8 years ago we didn’t really seem to “do” dying so the support wasn’t there. After a recent traumatic death I had lots of support. Much needed as I sobbed down the phone to @ClareFuller17 !!
@smillichope
30 January 2020 20:53
@Ian_CostelloNA @WeNurses I wonder if staff identify they feel desensitised what they would do. I spoke to a nurse who said she moved roles when she got to that point #wenurses
@HeatherStacey7
30 January 2020 20:54
Do you think the language of incident management has changed - have we moved to a human factors approach where we consider all aspects of care ? #WeNurses
@smillichope
30 January 2020 20:54
@carolgair @WeNurses what does good organisation support mean to you? #wenurses
@SueMarsden6
30 January 2020 20:54
@ClareFuller17 @WeNurses #wenurses I wonder how we can introduce them to the LD service?
@WeNurses
30 January 2020 20:54
This is good to hear ... we are so pleased you had support when needed #WeNurses https://twitter.com/SueMarsden6/status/1222986235280601088
@Ian_CostelloNA
30 January 2020 20:54
@SueS4sue @WeNurses #WeNurses I agree with you - focus should always focus on skill mix and supporting those that may struggle with emotion. The right support and the right mentoring makes the biggest difference. #Reflection is also key
@WeNurses
30 January 2020 20:54
Ooooh tricky question ... #WeNurses https://twitter.com/smillichope/status/1222986396337655808
@WeNurses
30 January 2020 20:55
And finally ... With 5 minutes left of tonights tweetchat, what are your take-a-way messages / actions re "Learning from deaths" ? #WeNurses https://t.co/ESAym7W04l
@WeNurses
30 January 2020 20:55
Another great question ... thoughts ?? #WeNurses https://twitter.com/HeatherStacey7/status/1222986368701411334
@SamSpence01
30 January 2020 20:55
@WeNurses I would say if you are in a resilient workplace yes. Personal resilience is more tricky as sometimes you’re doing ok yet it doesn’t take much to crumble and the support is not always there to catch you. #wenurses
@HeatherStacey7
30 January 2020 20:55
Good organisational support - for me a range of options and a focus on learning from when things go well and celebrating the successes #WeNurses
@SueMarsden6
30 January 2020 20:56
@WeNurses #wenurses late to the party but it’s reminded me that I know where to go for support but other colleagues might not, so “time to talk” is vital.
@WeNurses
30 January 2020 20:56
Some interesting thought here ... what do others think ? #WeNurses https://twitter.com/GillauraB/status/1222986808075739137
@Ian_CostelloNA
30 January 2020 20:56
@WeNurses #WeNurses - I have really discussed issues that 1 I am not majorly experienced with and 2 an area that I can develop by reading and discussing with others. Thank you for hosting this great topic
@carolgair
30 January 2020 20:56
@HeatherStacey7 As part of a PhD we looked at emotional impact of particular job role. Really raised awareness of the emotional responses to what was seen as routine/norm. Really useful exercise #wenurses
@SueS4sue
30 January 2020 20:57
@WeNurses Management that don't judge or belittle when you're dealing with these feelings. You can experience these things repeatedly but each affects you differently partly down to your resilience at that time #WeNurses
@smillichope
30 January 2020 20:57
@WeNurses thanks so much to everyone for your thoughts and answers to our questions it has been fascinating to hear what helps you with communication, support and learning #wenurses
@ClareFuller17
30 January 2020 20:57
@SueMarsden6 @smillichope @WeNurses It is an honour to work across teams and learn from each other @SueMarsden6 . Dying = something that impacts everyone and every specialty. #wenurses
@Ian_CostelloNA
30 January 2020 20:57
@nikkilouh @WeNurses #WeNurses - I agree with you for CPD
@HeatherStacey7
30 January 2020 20:57
take away message for me - There is great learning and practice out there - we need to learn to come together and share and shamelessly steal ! #WeNurses
@SueMarsden6
30 January 2020 20:57
@smillichope @carolgair @WeNurses #wenurses. Recognition of the need for time sometimes. Lots of deaths are good, and planned and expected but sometimes we need time and talking time or just tea. And silence to gather thoughts. Recognition of burnout and what it looks like (v individual)
@AgencyNurse
30 January 2020 20:57
@GillauraB @WeNurses I really like this point ... i'm not a fan of "resilience" ... being affected by death is a natural part of living and nursing ... it's ok not to be ok ... for me it's about support and as you say knowing you have done a good job #WeNurses
@smillichope
30 January 2020 20:58
@Ian_CostelloNA @WeNurses thanks so much for joining, your comments have been really interesting :) #wenurses
@HeatherStacey7
30 January 2020 20:58
thank you for sharing your thoughts and learning and being so open #WeNurses
@WeNurses
30 January 2020 20:58
RT @SueMarsden6: @smillichope @carolgair @WeNurses #wenurses. Recognition of the need for time sometimes. Lots of deaths are good, and plan…
@carolgair
30 January 2020 20:58
@smillichope @WeNurses I think recognising that people can be struggling and put help into place. Rather than people feeling they are failing. Recognising the emotional toll of nursing #wenurses
@SamSpence01
30 January 2020 20:58
@WeNurses Normalise conversations about death within your personal settings. As around to see what support is available in your workplace (preferably before you need it) Don’t feel you need all the answers. Remember no one (apart from maybe yourself) expects you to be perfect. #wenurses
@smillichope
30 January 2020 20:58
@nikkilouh @WeNurses we have examples from staff of training they have recommended. happy to share some of these if you have specific areas you are interested in #wenurses
@WeNurses
30 January 2020 20:58
Great take-a-way #WeNurses https://twitter.com/HeatherStacey7/status/1222987320833597440
@SueS4sue
30 January 2020 20:59
@WeNurses Start talking and keep talking #WeNurses
@Ian_CostelloNA
30 January 2020 20:59
#WeNurses really enjoyed tonight’s tweet chat - thank you once again. Look forward to the CPD pdf and creating a smart action plan for this @WeNurses
@Ian_CostelloNA
30 January 2020 20:59
RT @smillichope: @Ian_CostelloNA @WeNurses thanks so much for joining, your comments have been really interesting :) #wenurses
@WeNurses
30 January 2020 20:59
RT @SueS4sue: @WeNurses Start talking and keep talking #WeNurses
@Ian_CostelloNA
30 January 2020 20:59
@smillichope @WeNurses #WeNurses - thank you Steph ????
@ClareFuller17
30 January 2020 20:59
@WeNurses Agree - there is such a fine line and important to recognize when you can't switch and it begins to hurt too often too much #wenurses
@edfreshwater
30 January 2020 21:00
@smillichope @carolgair @WeNurses An organisation that values reflection, discussion, supervision and debriefing more than it values ICR completion rates #wenurses
@LeaBasra
30 January 2020 21:00
@WeNurses Agree if you dont get effected/saddened by some deaths then you may as well be a robot. But then if a death of a pt impacts negatively on you and your life then that is also not good its about getting a balance #wenurses
@smillichope
30 January 2020 21:00
@SamSpence01 @WeNurses great answer :) #wenurses
@WeNurses
30 January 2020 21:00
@Ian_CostelloNA always great to have you, pleased you enjoyed it Ian :) #wenurses
@AgencyNurse
30 January 2020 21:00
Take-a-way point for me ... support is key .... give support to collegues aswell as take it ... look after eachother .. nursing can be tough #WeNurses
@Ian_CostelloNA
30 January 2020 21:00
RT @WeNurses: @Ian_CostelloNA always great to have you, pleased you enjoyed it Ian :) #wenurses
@SueMarsden6
30 January 2020 21:00
@SamSpence01 @WeNurses #wenurses yes absolutely. Getting the language of dying right is so important. Our team finally now talk about patients “dying” not passing. If we get this right it demystifies it a little.
@WeNurses
30 January 2020 21:01
Thank you all for your tweets this evening - a tough topic which was sensitively handled by everyone #WeNurses https://t.co/J9qTtauudr
@AgencyNurse
30 January 2020 21:01
RT @WeNurses: Thank you all for your tweets this evening - a tough topic which was sensitively handled by everyone #WeNurses https://t.co…
@Ian_CostelloNA
30 January 2020 21:01
@WeNurses #WeNurses - I expect my involvement wheel to be improved using the right # correctly for a change! Need the practice now ??
@Anna_Chick
30 January 2020 21:01
@WeNurses To start conversations early and really listen.... and I’m still mortified about what I said to the Paeds consultant #wenurses
@CharCol2016
30 January 2020 21:01
@WeNurses Confidence, compassion, empathy, listening to patients and their families, being open, honest and using appropriate terminology which is to the point. Having the time to do it properly, if withdrawing treatment doing it on pts terms where able #wenurses
@Ian_CostelloNA
30 January 2020 21:02
#WeNurses - great feedback from the pro / master ?? https://twitter.com/AgencyNurse/status/1222988326430527488
@AgencyNurse
30 January 2020 21:02
@Anna_Chick @WeNurses next time i see you i feel i may b=need to randomly say "i love you" at some point ;D #WeNurses
@smillichope
30 January 2020 21:03
@WeNurses THANKS @WeNurses a fantastic conversation tonight #wenurses
@HeatherStacey7
30 January 2020 21:03
thank you #WeNurses
@AgencyNurse
30 January 2020 21:03
Thank you - it was an extremely valuable discussion #WeNurses https://twitter.com/smillichope/status/1222988616802218001
@DitsyRedOne
30 January 2020 21:03
@WeNurses Resilience is directly affected by workload, capacity + politics far more than most like to discuss. Pressures are varied + complex for staff + this impacts ability to provide safe effective care for all patients but EOL care is particularly emotionally draining. #WeNurses
@WeNurses
30 January 2020 21:03
Well done to @smillichope & @HeatherStacey7 for helping us bring up some really great ideas, experinces and learnings from tonights #wenurses Archived here http://wecommunities.org/tweet-chats/chat-details/5438 summary soon! https://t.co/Yf4Au4SXpu
@SueMarsden6
30 January 2020 21:03
@Anna_Chick @WeNurses #wenurses... what did you say to the paeds consultant? Sorry if this was earlier in the chat I was late...
@Anna_Chick
30 January 2020 21:04
@AgencyNurse @WeNurses Yes ! That would be brilliant hope to see you soon !!!! #wenurses
@WeNurses
30 January 2020 21:04
#WeNurses https://twitter.com/jenloweeee/status/1222988942657703937
@catwoman1979
30 January 2020 21:04
RT @WeNurses: Some interesting thought here ... what do others think ? #WeNurses
@jeanleo999
30 January 2020 21:04
@WeNurses #WeNurses I’m not sure it does. I am of the belief that what I tap into during that time is my empathy. I acknowledge resilience is important. But it is more emotional intelligence that’s needed here. After all who of us could not imagine going through something like this.
@WeNurses
30 January 2020 21:05
An extra special THANK YOU to @smillichope and @HeatherStacey7 who have been pretty fabulous guests this evening #WeNurses https://t.co/VzxayBMi8I
@WeNurses
30 January 2020 21:05
Don't forget WeLearn #AllOurHealth Mental Health & Wellbeing Week starts on Monday It's free and you simply use your Twitter details to log in > http://wecommunities.org/blogs/3521 #WeNurses https://t.co/08KMLLc2v5
@AgencyNurse
30 January 2020 21:06
Agreeeeeee awesome guests :D #WeNurses https://twitter.com/WeNurses/status/1222989126707879936
@CharCol2016
30 January 2020 21:06
@WeNurses Tea. Don't underestimate offering a hot drink. Time, a hug if appropriate, silence and you listening. Giving them a safe space to ventilate their feelings. Empathy and seeing you as approachable. Offer them comfort #wenurses
@WeNurses
30 January 2020 21:09
We can all learn from tonight's #wenurses Document it here in our super-dupa-deduppady FREE tweetchat CPD tool called #mywe Just log in here http://wecommunities.org/MyWe then scroll down to tonight's #wenurses chat to run through it! https://t.co/OqeV8NBj9L
@HeatherStacey7
30 January 2020 21:10
thanks to #wenurses and @smillichope for supporting a great chat - and to all those who took part https://twitter.com/WeNurses/status/1222988800219131918
@WeNurses
30 January 2020 21:10
RT @HeatherStacey7: thanks to #wenurses and @smillichope for supporting a great chat - and to all those who took part https://t.co/MBeFF8HD…
@Ian_CostelloNA
30 January 2020 21:15
RT @WeNurses: An extra special THANK YOU to @smillichope and @HeatherStacey7 who have been pretty fabulous guests this evening #WeNurses…
@KevinMurphyNHS
30 January 2020 21:16
RT @WeNurses: QUESTION 4 What support do you receive at work when there is a death? #WeNurses https://t.co/SlgkEJZva4
@DitsyRedOne
30 January 2020 21:18
@WeNurses We all know every patient is different, their journey is different and what matters to each of them is different and often EOL care is about drawing out the picture of what that journey looks like to the whole family. ....#WeNurses 1/2
@DitsyRedOne
30 January 2020 21:20
@WeNurses This tweet chat has made me reflect that ll of my staff also see the journey differently and have differing tool kits and experiences of ACP and bereavement and we would do well to have a session where we officially pool our resources to share best practice. #WeNurses 2/2
@lucy_dames
30 January 2020 21:20
@WeNurses Having the time to listen to families and explore their needs. Empathy but also a respect that it isn’t your grief and you are there to support and help #WeNurses
@NicolaFielding1
30 January 2020 21:23
@WeNurses This is always a challenge but education and experience increase confidence which definitely helps #WeNurses
@hepworth_becky
30 January 2020 21:44
@AgencyNurse @Anna_Chick @WeNurses Apologies for disappearing. Taxi duties. I couldn’t do leg ulcers.... good job we’re all different #wenurses




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